Ansiedade de pacientes em pré-operatório imediato em um hospital público do Distrito Federal

Introdução: A cirurgia é um momento delicado, um fato adventício que provoca uma transformação no estado emocional de cada pessoa, assim modificando o bem-estar, saúde e comportamento do indivíduo. Objetivos: Conhecer o nível de ansiedade dos pacientes em período pré-operatório em um Hospital Público da Rede Pública do Distrito Federal. Como objetivos específicos, identificar o perfil clínico do paciente em pré-operatório, classificar o nível de ansiedade segundo escala validada e relacionar o tipo do procedimento cirúrgico eletivo com o nível de ansiedade. Método: Trata-se de pesquisa descritiva, transversal, exploratória com abordagem, quantitativa. O estudo foi realizado em um Centro cirúrgico de um hospital público do Distrito Federal, no período de um mês (novembro de 2018). A coleta de dados foi realizada nas 24 horas que antecedem o procedimento cirúrgico através de um questionário confeccionado pela pesquisadora afim de atender aos objetivos deste trabalho. Cada entrevista teve duração de aproximadamente 40 minutos. Foram utilizados dois questionários: o primeiro refere-se à Sistematização da Assistência de Enfermagem (anexo A). O segundo questionário foi composto pela Escala Hospitalar de Ansiedade e Depressão (Hospital Anxiety and Depression Scale – HADS).

Prevalência de sintomas de disfunção temporomandibular, fatores associados e impacto sobre a qualidade de vida em usuários da rede de atenção primária à saúde

Introdução: Estudos epidemiológicos demonstram elevada prevalência de sinais e/ou sintomas de Disfunção Temporomandibular (DTM) na população adulta. Contudo, poucos estudos avaliaram esta disfunção na atenção primária à saúde. Objetivo: Avaliar prevalência de sintomas de DTM, fatores associados e, impacto sobre qualidade de vida em usuários da rede de atenção primária à saúde da cidade de Maceió/AL. Método: Avaliou-se 108 participantes quanto a presença de sintomas de DTM (índice anamnésico DMF),sintomas sugestivos de ansiedade e depressão (escala Hospital Anxiety and Depression- HAD), e sintomas sugestivos de estresse (Inventário de Sintomas de Stress para Adultos - ISSL); além da qualidade de vida relacionada a saúde oral, avaliada pela versão resumida do Oral Health-related (OHIP-14). Resultados: 55,6% apresentaram sintomas de DTM e 19,4% exibiram necessidade de tratamento. O sexo feminino e o autorrelato de hábitos parafuncionais foram preditores para os sintomas de DTM, e o estresse e hábitos para a necessidade de tratamento. Os sintomas de DTM, mesmo leves, promoveram impacto negativo sobre a qualidade de vida. Conclusão: Desta forma, os resultados apresentados sugerem necessidade de preparo e organização da rede de atenção à saúde, nos diferentes níveis, para garantir acesso e tratamento adequados aos pacientes com DTM e Dor Orofacial.

Het Effect van Hormoonbehandeling op het Emotioneel Welzijn en het Cognitief Functioneren van Transmannen

Transmannen zijn geboren met een vrouwelijk lichaam maar identificeren zich gevoelsmatig als man. In de huidige studie werd de invloed van hormoontherapie op het emotioneel welzijn en het cognitief functioneren van transmannen nagegaan. In het onderzoek participeerden 22 transmannen, en een controlegroep van 20 vrouwen en een van 19 mannen. De transmannen ontvingen gedurende 8 weken een voorbehandeling met een GnRH-analoog waarna als basismeting een testbatterij werd afgenomen. De testbatterij bestond uit vragenlijsten voor het meten van het emotioneel welzijn en bevatte tevens neuropsychologische testen om een aantal cognitieve vaardigheden te onderzoeken. Voor het meten van het emotioneel welzijn werden de Hospital Anxiety and Depression Scale (HADS) en de Symptom Checklist (SCL-90) gebruikt. De SCL-90 bestaat uit de subschalen Angst, Agorafobie, Depressie, Somatische klachten, Insufficiëntie van denken en handelen, Wantrouwen en interpersoonlijke sensitiviteit, Hostiliteit en Slaapproblemen. Na de 8 weken voorbehandeling kregen de transmannen 16 weken testosteron (met daarnaast een GnRH-analoog en een aromataseremmer) toegediend. Hierna werd opnieuw dezelfde testbatterij afgenomen. De controlegroepen ontvingen gedurende het gehele onderzoek geen interventie. Bij alle onderzoeksgroepen werd op dezelfde momenten de testbatterij afgenomen. Verwacht werd dat de hormoonbehandeling een (positief of negatief) effect zou hebben op het emotioneel welzijn (depressie, angst en psychologische symptomen) van de transmannen. Daarnaast werd verwacht dat het cognitieve profiel van de transmannen als gevolg van de hormoonbehandeling zou verschuiven van een relatief ‘vrouw-typisch’ cognitief profiel (sterke verbale vaardigheden) naar een ‘man-typisch’ cognitief profiel (sterk ruimtelijk inzicht). Met betrekking tot executief functioneren en verbaal geheugen werd geen invloed verwacht en ten aanzien van verwerkingssnelheid was het onderzoek exploratief. De resultaten laten geen verandering zien in het emotioneel welzijn ten gevolge van de hormoontherapie. De resultaten konden ook niet alle verwachte cognitieve effecten bevestigen. Het vermoeden dat hormoontherapie geen invloed zou hebben op het executief functioneren en het verbale geheugen van de transmannen werd wel bevestigd in deze studie. Tot slot werd tegen de verwachting in geen effect gevonden van de hormoontherapie op snelheid van de informatieverwerking. Wel gaven de resultaten van de SCL-90 aan dat transmannen gemiddeld hogere scores hadden op de slaap- en hostiliteitsschaal dan vergelijkingsgroepen van vrouwen en mannen. Vervolgonderzoek naar de verschillen tussen transpersonen en controlegroepen en de invloed van hormoonbehandeling op emotioneel welzijn en cognitief functioneren is noodzakelijk om de transgenderzorg indien nodig te verbeteren.

Efeitos do agulhamento seco profundo no tratamento da disfunção temporomandibular: estudo de casos

O presente estudo teve como objetivo avaliar a eficácia do agulhamento seco profundo para o tratamento de disfunção temporomandibular (DTM) por meio da escala numérica de dor, escala hospitalar de ansiedade e depressão e abertura bucal. Três pacientes foram avaliados e diagnosticados com DTM por exame clínico baseado Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Também foi avaliada a intensidade da dor por meio da escala numérica de dor, mensuração da abertura bucal (com paquímetro) e questionário Hospital Anxiety and Depression Scale (HADS) para avaliação de ansiedade e depressão. O agulhamento seco nos pontos gatilhos nos músculos masseter e temporal foi realizado por meio de agulhas 0,20 x 13 mm. Após 4 semanas de tratamento, 1 sessão por semana, os resultados demonstraram que uma paciente tinha DTM mista e os outros 2 miógena; que a intensidade de dor e pontuação do questionário HADS para ansiedade e depressão diminuíram para todos os pacientes e promoveu o aumento da abertura bucal na paciente que estava com limitação. Em conclusão, o agulhamento seco nos pontos gatilhos ativos nos músculos masseter e temporal em pacientes com DTM miofascial apresentou melhora clínica importante após 4 semanas de tratamento como resolução da dor e diminuição da ansiedade e depressão.

Influencia de la ansiedad e insatisfacción corporal sobre conductas alimentarias de riesgo en una muestra de mujeres adolescentes de México

La insatisfacción corporal (IC) es un predictor importante de conductas alimentarias de riesgo (CAR), aunque la IC comúnmente se presenta con sintomatología de ansiedad, se desconoce si esta modera la relación entre la IC y las CAR en población adolescente. Objetivo: analizar el efecto moderador de la sintomatología de ansiedad en la relación entre la IC y las CAR. Método: Estudio transversal explicativo. Muestreo no probabilístico n = 500 mujeres adolescentes escolarizadas, edades entre los 14 y 19 años (M = 16.81, DE = 1.33). Las participantes respondieron el Eating Attitudes Test-26, Body Shape Questionnaire-8D y Hospital Anxiety and Depression Scale. Se obtuvo consentimiento informado de padres/tutores y asentimiento informado de participantes. Resultados: la sintomatología de ansiedad moderó la relación entre la IC y las CAR, asociación más fuerte en niveles altos de ansiedad (b = .51, p < .001) que en bajos niveles (b = .32, p < .001). Análisis post-hoc mostraron que las pendientes de sintomatología de ansiedad alta vs baja fueron significativamente diferentes (t = 2.90; p < .001). Discusión: La ansiedad modera la relación de dos predictores de trastornos alimentarios, influyendo en el aumento del riesgo a desarrollarlos. Se discuten implicaciones prácticas a nivel de prevención y tratamiento de los trastornos alimentarios.

Revisión sistemática de la Escala de Ansiedad y Depresión Hospitalaria (HADS) en muestras mexicanas. ¿Debemos regresar al principio?

Systematic review of the psychometric properties of the Hospital Anxiety and Depression Scale (HADS)in Mexican samples: Should we go back to the beginning Abstract: A systematic review was run in order to find validation studies on the Hospital Anxiety and Depression Scale (HADS) in Mexican samples. Specialized databases and referencia sections of some articles were searched to locate this evidence. We found 10 articles that analyzed the psychometric properties of the HADS. The analysis showed that in all of the studies reliability was adequate and generally a two-factor structure could be supported. Nevertheless, we identified five different versions of the HADS and did not find any information about the translation process. In conclusion, the adequate internal consistency of the HADS could be confirmed but regarding the two-factor structure and cut-off points evidence is not conclusive. Key words: HADS; reliability; validity; psychometric properties; Mexico. Resumen: El propósito de esta investigación fue realizar una revisión sistemática de los estudios de validación de las propiedades psicométricas de la Escala de Ansiedad y Depresión Hospitalaria (HADS) en muestras mexicanas. Se realizó una búsqueda en bases de datos especializadas y en las referencias de los artículos. Se encontraron 10 estudios en los que se analizaron las propiedades psicométricas de la HADS. El análisis mostró que en todas las invesigaciones se evaluó la fiabilidad y ésta fue adecuada; en general, los estudios apoyan una estructura de dos factores. Sin embargo, se identificaron cinco versiones diferentes de la HADS y no se encontró información sobre cómo se realizó la traducción. En conclusión, se confirma que la consistencia interna de la HADS es adecuada, si bien los estudios apoyan la estructura de dos factores la evidencia no es concluyente, como tampoco lo es respecto a los puntos de corte. Palabras clave: HADS; fiabilidad; validez; propiedades psicométricas; México.

Maternal Mental Health Following Ultrasonographic Detection of Fetal Structural Anomaly in the Midst of the COVID-19 Pandemic

Prenatal ultrasonographic detection of fetal structural anomaly may adversely affect maternal mental health throughout pregnancy, particularly in the current COVID-19 pandemic. This study aims to prospectively assess maternal stress, anxiety, and depression following ultrasonographic detection of fetal structural anomaly from diagnosis until delivery during the COVID-19 pandemic. A total of 141 pregnant women at a tertiary hospital who underwent detailed scans between 16 and 24 gestational weeks were included and categorized into the study (anomaly finding, n = 65) and comparison (normal finding, n = 76) groups. Self-administered questionnaires of 10-item Perceived Stress Scale (PSS-10) and Hospital Anxiety and Depression Scale (HADS) were used to assess maternal stress, anxiety, and depression at prior detection (T1), two-to-four weeks post-detection (T2), one-to-two weeks prior to delivery (T3), and one-to-two weeks post-delivery (T4). Repeated measures of analysis of variance (ANOVA) were conducted to assess time-, between-group, and time–group interaction effect. In general, maternal stress improved, but anxiety worsened, while depression persisted, over the time from T1 to T4. The average maternal stress and anxiety levels were significantly higher among groups with fetal anomaly. The maternal stress and anxiety level were significantly affected within one-to-two weeks post-detection of fetal structural anomaly. In conclusion, maternal mental health parameters were affected differently during the COVID-19 pandemic, with higher vulnerability of stress and anxiety among pregnant women with fetal structural anomaly particularly within one-to-two weeks post-detection.

Association Between Levels of Depression Symptoms and Moderately Increased Levels of the Inflammation Marker Albuminuria Is Explained by Age and Comorbidity.

Background: The study aimed to examine whether there are associations between levels of depression symptoms and levels of the inflammation marker albuminuria. Materials and methods: The 8303 participants in this cross-sectional study were subjects from the second survey of the Trøndelag Health Study (HUNT, Norway). Depression symptoms were assessed by the Hospital Anxiety and Depression Scale (HADS). Logistic regression analysis was performed to estimate the odds ratio (OR) for moderately increased albuminuria (ACR > 3.0 mg/mmol) according to different HADS subgroups and -scores.Results: Unadjusted ORs for moderately increased albuminuria were significantly increased in those with HADS > 8 (OR 1.27, 95% CI 1.05-1.54, p=0.013) and HADS > 11 (OR 1.59, 95% CI 1.19-2.14, p=0.002). However, after adjusting for age and sex, only HADS > 11 was significantly associated with ACR > 3.0 mg/mmol (OR 1.46, 95% CI 1.08-1.98, p=0.014), and after multivariable adjustments for cardiovascular risk factors and comorbidity, there were no significant associations. Conclusion: The positive and significant association between moderately increased albuminuria and symptoms of depression found in unadjusted analyses weakened and disappeared after adjustments. Although individuals with depressive symptoms had albuminuria more often than individuals without such symptoms, albuminuria may reflect other comorbidity and inflammation conditions than depression.

Non-motor manifestations in patients with Parkinson's disease

Objective: to study the structure of NMS, their frequency and clinical significance at all stages of PD; to conduct a comparative analysis of the structure of NMS in PD, depending on the stage, form of the disease and gender characteristics of patients.Material and methods: examined 100 patients with PD, 31 patients as the control, and 11 patients as the comparison with Parkinson’s syndrome. The severity of movement disorders was assessed using the Hen and Yar scale. All patients with PD were also clinically assessed according to the UPDRS scale (parts II, III). Cognitive functions were assessed according to the Montreal CI scale (MOCA). The patients’ neuropsychological status was assessed using the Hospital Anxiety and Depression Scale (HADS).Results: vegetative disorders are a frequent manifestation of PD; they differ significantly depending on the gender of the patient and on the stage of the disease. In 20% of patients with PD clinically pronounced depression and severe cognitive impairment were revealed. Conclusion: non‑motor disorders are distinguished by a wide variety of manifestations and combinations, and their structure changes significantly from early to late stages of PD. The presence of NMS is an obligatory sign of PD. Although the structure of non‑motor manifestations of the disease is not specific, attention is drawn to the combination of more than ten different NMS in most patients, which does not occur with natural aging.